Dec 7 Hidden Dangers in a Safe Shock, ECT and Personhood

Electroconvulsive therapy (ECT) ameliorates a number of entrenched psychological conditions through the electrical stimulation of the brain.1 It employs safe, square wave impulses to induce manageable seizures.1 The therapy is effective in a number cases where other treatments have failed.2 It uses less electrical current than a single light bulb.2 With these realities in mind, the immediate impulse is to ensure easy access by classifying ECT as a minimal or moderate risk procedure. A closer look reveals a better course of action. With the Food and Drug Administration (FDA) in the midst of a reexamination of this therapy, this consideration is timely.

To interpret personhood is to consider a holistic amalgam of memory, behavior, personality, and cognition. The essence of personhood lies in the tenuous relationship of these interplaying factors. Our very being lies in the dynamic relationships of deceptively complex parts. The interactions are frail, fleeting, subject to external perturbation. The character of the factors ebbs and flows. Their influence waxing and waning at every moment. In a sterile way, we are in the circuitry and chemistry of the mind. It would seem we are so much more. The roots of personhood may remain evasive despite ever-increasing pursuit in science and medicine.

Memory, behavior, personality, and cognition, treating adverse mental states necessarily disrupts these aspects of personhood. The consideration of how a therapy alters who we are is as necessary as the investigation of its safety. Equating a change in personhood with a death works to display how the mind is central to who we are. But, does ECT amount to an unacceptable disruption to the choreography of mental parts?

Does ECT impact memory? Yes. The majority of patients experience severe disorientation and retrograde amnesia following treatment.3 In this case, retrograde amnesia signifies the loss of memory from several weeks or months prior.3 Further ethical issues that arise when one considers that consent to the therapy’s use may fall in this period. This loss may be nonfatal. It is still a serious side-effect. Patients forget a day’s events leading up to treatment and a third of them report memory loss persisting for more than six months.1,4 Our experiences and how we internalize them plays into who we are. ECT is impacting our memories.

Does ECT alter behavior? Yes. In autistic patients with a tendency towards self-harm ECT has been shown to dramatically reduce the number of times they hurt themselves.1 In cases of chronic depression where drugs have provided no relief ECT has been shown to increase interaction and engagement.2 These may be positive changes but they could also be indicative of other alterations in behavior. What we do is an aspect of who we are. ECT is altering our behavior.

Does ECT change personality? Yes. Bluntly, ECT can help people overcome depression.2 The gradual recovery from a period of deep depression to one of normal functioning or emotional stability is an extreme change in personality. Again, this change is good. Is it indicative of other, less positive changes in personality? If ECT can help to moderate something as intense as depression, perhaps its effects on personality are broader. Our personality is a key aspect of who we are. ECT has the potential to change personality.

Does ECT affect cognition? Yes. Cognitive damage and emotional duress are occasionally reported by those undergoing electroconvulsive therapy.3 Our cognitive abilities and emotional positions play into who we are. ECT can affect cognitive ability.

I understand that for some people ECT is the answer. I reaffirm that the treatment has merit and that the treatment of a psychological condition necessarily changes some of the mental functions described. But we don’t know how ECT works.1 Right now it is too broad a tool. Its unrefined status poses unnecessary dangers to who we are as individuals. ECT has the potential to change a person in ways that should be avoided if possible.

To this end, I suggest that retaining the “high-risk” label ensures sufficient access to those who have sought out safer alternatives. This classification will also suggest that research on ECT and ECT alternatives is needed. Stagnation in medical research may occur due to a perceived solution. Because of the risks to what makes someone an individual ECT is not yet a solution. Let’s not make it a danger by decreasing its risk level.

References:

Mandavill, A. (2016, October 27). How ‘Shock Therapy’ Is Saving Some Children With Autism. Accessed November 15, 2016. http://www.theatlantic.com/health/archive/2016/10/how-shock-therapy-is-saving-some-children-with-autism/505448/

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